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CategoryHealthcare
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No of Jobs1
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Apply Before10/01/2025
Description
Utilization Management Nurse Consultant - Remote Work
The Muse - Juneau, AK
Job Title: Utilization Management Nurse Consultant - Remote Work
Position: Utilization/Benefit Management Coordinator
Job Type: Full Time
Pay: $26.01 - $74.78
Shift: Monday-Friday: 11:30am-8:00pm EST; 8:30am-5:00pm PST; or 9:30am-6:00pm MST; weekend/holiday coverage occasionally required.
Work Type: Remote
Location
Address:
City: Juneau
State: AK
ZIP Code:
Job Responsibilities
- Utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
- Collaborate to assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services/benefits.
- Gather clinical information and apply relevant clinical criteria, guidelines, policies, and clinical judgment for coverage determinations.
- Communicate with providers and others to facilitate care and treatment.
- Identify members for referral opportunities to integrate with other products, services or programs.
- Consult and lend expertise in the coordination and administration of the utilization/benefit management function.
- Function in a clinical telephone queue working with providers for prior authorization reviews.
Required Skills
Core Skills
- Clinical experience in utilization management or prior authorization
- Decision-making using clinical judgment
- Proficient use of equipment including phone, computer and clinical documentation systems
Preferred Skills
- 1+ years Managed Care experience
- 1+ years in a high volume clinical call center environment
- Remote work experience
Requirements
Experience: 1 year UM, concurrent review or prior authorization; 5 years of clinical experience required.
Education: Associate's nursing degree (RN) minimum required; Bachelor's degree preferred.
License & Certification:
- Registered Nurse with an unrestricted license in their state of residence
- Ability to be licensed in all non-compact states
Schedule:
- First 3 weeks on camera training required with 100% participation.
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan with matching contributions
- Employee stock purchase plan
- No-cost wellness programs including screenings and counseling
- Paid time off and flexible work schedules
- Dependent care resources and tuition assistance
Supplemental Pay
- Eligibility for a CVS Health bonus, commission or short-term incentive program in addition to base pay.
Special Notes
- Organizational commitment to diversity and inclusion.
- Qualified applicants with arrest or conviction records will be considered for employment in accordance with all laws.
Facility Details
Name: The Muse
Description: A leading health solutions company providing care through local presence and digital channels.
Specialties:
- Medical Management
- Case Management
- Disease Management
- Utilization Management
Mission: To build a world of health around every consumer.
Job Info
